Saturday, November 5, 2016

What’s the Noakes Hearing Really About? And Who is Winning It?

The Noakes hearing in South Africa has been going on for years, and will likely take at least five more months to finish. What is it about and how is it going? Who is winning?

To bring some clarity to all this we asked Dr. Zoë Harcombe, one of the expert witnesses in the case, to explain it all in simple terms. The following is written by her:

What’s this all about?

It started with a tweet, would you believe! On 3 Feb 2014, @pippaleenstra tweeted: “@ProfTimNoakes @SalCreed is LCHF eating OK for breastfeeding mums? Worried about all the dairy + cauliflower = wind for babies??” (@SalCreed is Sally-Ann Creed, a co-author of The Real Meal Revolution with ProfTN, as we’ll call The Prof from now on).

On 6 Feb 2014, at 6.27am, a dietician called Claire Julsing Strydom, who tweets as @DietitianClaire, tweeted “@ProfTimNoakes @PippaLeenstra Pippa please contact me on 011 023 8051 or Claire@nutritionalsolutions.co.za for evidence based advice”

Barely two hours later, @DietitianClaire had reported ProfTN to the Health Professions Council of South Africa (HPCSA). ProfTN first heard of the complaint on 20 Feb 2014 and sent a reply on 2 May 2014. Full details of what transpired are available for my club members here, here and here. The headline is as follows:

The charge and hearings

It became known during the hearings that the decision to charge ProfTN had been made in September 2014, but that this was not communicated to him until January 2015. The charge was one of unprofessional conduct “in that you provided unconventional advice on breastfeeding babies on social networks (tweet).”

The first hearing (4-5 June 2015) was aborted because the HPCSA did not convene a panel that met its own regulations! The second hearing (23 Nov – 2 Dec 2015) was taken up with witnesses for the HPCSA and cross-examination of those witnesses. The prosecution case ended during the 8-17 Feb 2016 hearing and this is when ProfTN finally took the stand. The most recent hearing was held between 17-26 October and this saw the completion of evidence given by ProfTN, several days of cross-examination and then three witnesses for the defence: Nina Teicholz, Caryn Zinn and I.

What the prosecution needs to show

The prosecution (HPCSA) needs to establish two things:

That ProfTN was in a doctor patient relationship with the tweeter, Ms Leenstra (failing this, ProfTN is not subject to ethical rules of conduct and any ‘advice’ would no longer qualify as such);

That unconventional advice was given.
In my opinion, and that of ProfTN’s legal team, the prosecution has failed to establish that there was a doctor patient relationship. (This will not surprise anyone familiar with twitter, who will find the mere suggestion that twitter is a doctor’s surgery quite absurd!) This was established quite brilliantly by ProfTN’s legal team during their cross-examination of prosecution witnesses – particularly during cross-examination of the complainant @DietitianClaire). These were the three key punches:

i) Many people replied to Ms Leenstra’s tweet (as happens with twitter) – including @DietitianClaire. Were doctor patient relationships established with all respondents?

ii) The HPCSA ethics code states that a practitioner shall not take over a patient unless you inform the other practitioner and unless the change is at the patient’s request. If a doctor patient relationship had been established with ProfTN and Ms Leenstra, then @DietitianClaire would be guilty of trying to take that patient over!

iii) @DietitianClaire went way further than ProfTN – she offered her phone number and email and ended up holding a phone consultation, yet still did not consider Ms Leenstra to be her patient.

The defence could have rested at this point and argued that there is no doctor patient relationship and therefore there is no misconduct possible. However, ProfTN has taken the opportunity to put dietary advice on trial. The second part of the charge, about unconventional advice, has become a debate about evidence-based advice i.e. if advice is different to that given by public bodies, but it is evidence-based, is it unconventional? Conversely, if advice given by public bodies is not evidence-based, should it be seen as unconventional?

This is what has been challenged since ProfTN took the stand in Feb 2016 and that’s why Nina, Caryn and I ended up in Cape Town for several days in October.

What happens next?

Closing arguments will be presented to the six person panel on 4 & 5 April 2017. The panel will deliberate on 6 & 7 April and the verdict will be delivered on 21 April 2017.

I personally cannot see legally how ProfTN can be found guilty of misconduct in the absence of a doctor patient relationship. However, given that the HPCSA announced on Friday 28th October that ProfTN had been found guilty – almost six months before closing arguments will even be heard – who knows what will happen in this case.

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About Me

I maintain the academic record of all students and plans and implements the registration process for classes, I also works with other administrators to coordinate times and locations for class meetings and resolve scheduling conflicts.